Causes and characteristics, Treatment
A pattern of behavior that is verbally or physically harmful to other people, animals, or property, including behavior that severely violates social expectations for a particular environment.
Antisocial behavior can be broken down into two components: the presence of antisocial (i.e., angry, aggressive, or disobedient) behavior and the absence of prosocial (i.e., communicative, affirming, or cooperative) behavior. Most children exhibit some antisocial behavior during their development, and different children demonstrate varying levels of prosocial and antisocial behavior. Some children may exhibit high levels of both antisocial and prosocial behaviors; for example, the popular but rebellious child. Some, however, may exhibit low levels of both types of behaviors; for example, the withdrawn, thoughtful child. High levels of antisocial behavior are considered a clinical disorder. Young children may exhibit hostility towards authority, and be diagnosed with oppositional-defiant disorder. Older children may lie, steal, or engage in violent behaviors, and be diagnosed with conduct disorder. Mental health professionals agree, and rising rates of serious school disciplinary problems, delinquency, and violent crime indicate, that antisocial behavior in general is increasing. Thirty to 70% of childhood psychiatric admissons are for disruptive behavior disorders, and diagnoses of behavior disorders are increasing overall. A small percentage of antisocial children grow up to become adults with antisocial personality disorder, and a greater proportion suffer from the social, academic, and occupational failures resulting from their antisocial behavior.
Causes and characteristics
Factors that contribute to a particular child's antisocial behavior vary, but usually they include some form of family problems (e.g., marital discord, harsh or inconsistent disciplinary practices or actual child abuse, frequent changes in primary caregiver or in housing, learning or cognitive disabilities, or health problems). Attention deficit/hyperactivity disorder is highly correlated with antisocial behavior. A child may exhibit antisocial behavior in response to a specific stressor (such as the death of a parent or a divorce) for a limited period of time, but this is not considered a psychiatric condition. Children and adolescents with antisocial behavior disorders have an increased risk of accidents, school failure, early alcohol and substance use, suicide, and criminal behavior. The elements of a moderate to severely antisocial personality are established as early as kindergarten. Antisocial children score high on traits of impulsiveness, but low on anxiety and reward-dependence—that is, the degree to which they value, and are motivated by, approval from others. Yet underneath their tough exterior antisocial children have low self-esteem.
A salient characteristic of antisocial children and adolescents is that they appear to have no feelings. Besides showing no care for others' feelings or remorse for hurting others, they tend to demonstrate none of their own feelings except anger and hostility, and even these are communicated by their aggressive acts and not necessarily expressed through affect. One analysis of antisocial behavior is that it is a defense mechanism that helps the child to avoid painful feelings, or else to avoid the anxiety caused by lack of control over the environment.
Antisocial behavior may also be a direct attempt to alter the environment. Social learning theory suggests that negative behaviors are reinforced during childhood by parents, caregivers, or peers. In one formulation, a child's negative behavior (e.g., whining, hitting) initially serves to stop the parent from behaving in ways that are aversive to the child (the parent may be fighting with a partner, yelling at a sibling, or even crying). The child will apply the learned behavior at school, and a vicious cycle sets in: he or she is rejected, becomes angry and attempts to force his will or assert his pride, and is then further rejected by the very peers from whom he might learn more positive behaviors. As the child matures, "mutual avoidance" sets in with the parent(s), as each party avoids the negative behaviors of the other. Consequently, the child receives little care or supervision and, especially during adolescence, is free to join peers who have similarly learned antisocial means of expression.
Different forms of antisocial behavior will appear in different settings. Antisocial children tend to minimize the frequency of their negative behaviors, and any reliable assessment must involve observation by mental health professionals, parents, teachers, or peers.
The most important goals of treating antisocial behavior are to measure and describe the individual child's or adolescent's actual problem behaviors and to effectively teach him or her the positive behaviors that should be adopted instead. In severe cases, medication will be administered to control behavior, but it should not be used as substitute for therapy. Children who experience explosive rage respond well to medication. Ideally, an interdisciplinary team of teachers, social workers, and guidance counselors will work with parents or caregivers to provide universal or "wrap-around" services to help the child in all aspects of his or her life: home, school, work, and social contexts. In many cases, parents themselves need intensive training on modeling and reinforcing appropriate behaviors in their child, as well as in providing appropriate discipline to prevent inappropriate behavior.
A variety of methods may be employed to deliver social skills training, but especially with diagnosed antisocial disorders, the most effective methods are systemic therapies which address communication skills among the whole family or within a peer group of other antisocial children or adolescents. These probably work best because they entail actually developing (or redeveloping) positive relationships between the child or adolescent and other people. Methods used in social skills training include modeling, role playing, corrective feedback, and token reinforcement systems. Regardless of the method used, the child's level of cognitive and emotional development often determines the success of treatment. Adolescents capable of learning communication and problem-solving skills are more likely to improve their relations with others.
Unfortunately, conduct disorders, which are the primary form of diagnosed antisocial behavior, are highly resistant to treatment. Few institutions can afford the comprehensiveness and intensity of services required to support and change a child's whole system of behavior; in most cases, for various reasons, treatment is terminated (usually by the client) long before it is completed. Often, the child may be fortunate to be diagnosed at all. Schools are frequently the first to address behavior problems, and regular classroom teachers only spend a limited amount of time with individual students. Special education teachers and counselors have a better chance at instituting long-term treatment programs—that is, if the student stays in the same school for a period of years. One study showed teenage boys with conduct disorder had had an average of nine years of treatment by 15 different institutions. Treatments averaged seven months each.
Studies show that children who are given social skills instruction decrease their antisocial behavior, especially when the instruction is combined with some form of supportive peer group or family therapy. But the long-term effectiveness of any form of therapy for antisocial behavior has not been demonstrated. The fact that peer groups have such a strong influence on behavior suggests that schools that employ collaborative learning and the mainstreaming of antisocial students with regular students may prove most beneficial to the antisocial child. Because the classroom is a natural environment, learned skills do not need to be transferred. By judiciously dividing the classroom into groups and explicitly stating procedures for group interactions, teachers can create opportunities for positive interaction between antisocial and other students.
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